Peter Sims
A Public Health Odyssey 1973-2015

My own experience was essentially positive, probably helped by working as a GP and as an academic in other countries

I qualified first in Dentistry in 1965 determined to continue with Medicine and a career as an oral surgeon or in dental medicine. An oral surgery job in Scotland was interesting but not for a lifetime and returning to Medicine I became  fascinated by Social Medicine, The teaching was uninspired but then  I got to know Jock Anderson, the Head of Department and he listened, guided and supported me.

I qualified in 1969 and there were house jobs at Guy’s and Guildford but a desire to go to Africa where Jock advised I could get maximum experience across the spectrum. Wife, and 3-month son we sailed for Cape Town and on to Zambia…. On my return 3 years on he supported my application for the 2-year MSc at LSHTM. The MSC.in Social Medicine was designed for the new Public health role of the 1974 reorganisation with  a different background and content from the Diploma in Public Health (DPH), and as  NHS consultants an end to the medical snobbery directed at the Medical Officer of Health (MoH). It was two years, a whole year for a research project and enlightened teaching in Sociology, Economics, Epidemiology, Statistics, Management-but best by far the other people on the course,  with a good deal of clinical experience but a genuine interest in a community and preventive approach with  an understanding of information and to make for efficient and effective services within a cost envelope.

I was appointed to Tower Hamlets (TH) as District Community Physician-Director of Public Health (DCP) in 1976 and was there until1981. I was single handed and also managed Infectious Disease and hazards like asbestos.   There were major health issues, homeless alcoholics with TB and Bengali immigrants in sweat shops, in squalid accommodation and with TB, Typhoid, Diphtheria…19th century stuff. No body quite knew what a DCP did, so I followed my instincts in a deprived part of London with a famous teaching hospital and consultant prima donnas. I also worked quite a lot in the old MoH model with the LA, attending meetings, medical housing, school health…and the Winter of Discontent plus major industrial action by the Health Unions. Frank Murphy was Area Medical Officer; Paul Walker at Region and Spence Galbraith at Colindale-it was a time of hope and real change. The new entrants were among the brightest and best. The DC P was on the District Management Team (DMT) and on the whole was supported by the other members who were much more hospital animals. I was also on several key Hospital committees

I persuaded the Health Authority (HA) to let me do a year as a P/Trainee GP, a further re-organisation was coming. I had done a lot of GP locums (to supplement our income with a young family).  In 1980 I was offered a partnership in Bedfordshire where we had done several locums. The practice agreed I spend 2 days a week in Public Health Medicine (PHM) my salary going into the practice earnings and I did 2 days a week in Luton working mainly in planning and supporting /deputising for the DCP (the unfortunate David Josephs who became a good friend and took his own life).

After 8 years as a partner we wanted to get away from the London orbit and after a few attempts got the DPH job in North Devon in 1989. We have lived here since. Again (as in TH) I was singlehanded and had time and space to do my own thing. Again I worked across the interface with the Local Authority (LA) and in the MoH mode, this worked well and with excellent GP’s and Consultants, a new Hospital, and no serious deprivation the NHS performed well. I got much involved with the health problems of sheep dip in armers.

When North Devon joined with Exeter, I did not get the DPH job and after several tries in Britain   I went again to Zamia as an academic teaching Social Medicine and a Master of Public (MPH) course for 3 years. There was quite a bit of clinical medicine too-I visited a mission hospital alternate weekends where there was no doctor.

Returning to Britain in 1998 I could not get a job in PHM-too old, too experienced, a loose cannon… several long locums and the best  a long appointment looking at rare diseases which cost a lot and have to be planned and organised at regional or national level. (Transplants, Spinal Injury, Cardiac surgery) This was fascinating and with computers and enlightened statisticians it was possible to build costed models of care reflecting need, demand, and practice.

However when I struggled to get work I had applied for an academic job in Papua New Guinea-they tardily got in touch and after  some heart searching went again alone (dangerous for wives)  to teach mainly PHM as an MPH but also a whole  range of stuff to undergraduates-from biochemistry to forensic psychiatry…

On return and I had my NHS pension by then, I did 5 years as a GP with the British Army, and became involved with various national bodies e.g. NICE

I liked being in the NHS rather than the LA and being able to talk “doctor to doctor with clinicians. I was working before the purchaser provider split and this is now much more difficult. I regret the loss of the Medicine in PHM, the PH team needs Medicine as well as economics, geography, sociology, statistics to function well, to reach out to equivalent areas/ skills in LA or NGO’s.

On the whole I was disappointed by the Faculty-in particular for their shameful lack of support to David Josephs and their havering over Nuclear weapons. I liked and respected Alwyn Smith and John Ashton but there seemed little leadership or challenge-thus HIV, Covid-19, Obesity little but words. The BMA Board of Science produced good science, Brian Jarman measured deprivation and health. Michael Marmot’s stuff very much PHM’s agenda. (perhaps sour grapes for when I offered my talents they were refused!)

 Other doctors in PHM?-, generally good experiences, (a few rogues, idlers, and villains but so it is everywhere) and excellent registrars,who became good friends…on the whole I do not have many doctors as friends- they can be a bit pompous and self-important; today’s GP’s and Consultants seem more open and easier now we need care ourselves!

So a fortunate man, a mix of success and failure but the flexibility of a clinical base and a fascinating time to be in medicine-I would not have missed it